Methods and devices for creating tissue plications

Abstract

Devices and methods for forming and securing a tissue plication are disclosed herein. In one aspect, a tissue manipulation device is described that includes a first jaw member pivotally coupled to a distal end of an elongate shaft and having an articulating portion located distal to the proximal end of the first jaw member. The device also includes a second jaw member pivotally coupled to the first jaw member such that the jaws move in a first plane, and a fastener delivery member attached to the second jaw member. The articulating portion of the first jaw member is configured to move the first and second jaw members between a straight configuration in which a longitudinal axis of the elongate shaft is contained within the first plane and an articulated configuration in which the longitudinal axis of the elongate shaft is transverse to the first plane.

What is claimed is: 
     
       1. A method of acquiring and fixating tissue, comprising:
 inserting into a body lumen a tissue grasper, an elongate shaft, and an end effector coupled to the elongate shaft, wherein the end effector has a first jaw that pivots relative to a second jaw in a first plane and about an axis that extends through a proximal end of the first jaw and a portion of the second jaw; 
 pivoting the first and second jaws in a direction transverse to the first plane such that the first and second jaws move from a first configuration, in which a longitudinal axis of the elongate shaft lies in the first plane, to a second configuration, in which the longitudinal axis of the elongate shaft is transverse to the first plane; 
 positioning the tissue grasper to engage tissue; 
 drawing the tissue through the first and second jaws by moving the tissue grasper transversely with respect to the first plane when the first and second jaws are in the second configuration; and 
 delivering a fastener through the tissue disposed between the first and second jaws from a fastener delivery member coupled to the second jaw; 
 wherein the first plane is defined by proximal and distal ends of each of the first and second jaws in both the first configuration and the second configuration. 
 
     
     
       2. The method of  claim 1 , wherein inserting the end effector and elongate shaft into the body lumen comprises positioning the elongate shaft perpendicular to an inner surface of the body lumen, and pivoting the first and second jaws in the direction transverse to the first plane comprises positioning the first and second jaws such that a longitudinal axis of any of the first and second jaws is parallel to the inner surface of the body lumen. 
     
     
       3. The method of  claim 1 , wherein moving the tissue grasper transversely with respect to the first plane comprises moving the tissue grasper perpendicular to a longitudinal axis of any of the first and second jaws. 
     
     
       4. The method of  claim 1 , wherein pivoting the first and second jaws in the direction transverse to the first plane includes translating an articulation actuating member parallel to the longitudinal axis of the elongate shaft. 
     
     
       5. The method of  claim 1 , wherein delivering the fastener includes moving the fastener delivery member from a low-profile delivery configuration in which the fastener delivery member is positioned substantially within a channel formed in the second jaw to an open configuration in which a distal portion of the fastener delivery member is positioned substantially outside of the channel. 
     
     
       6. The method of  claim 5 , wherein delivering the fastener further includes extending a needle from the fastener delivery member such that the needle passes through openings formed in the first and second jaws, as well as through the tissue disposed therebetween. 
     
     
       7. A method of acquiring and fixating tissue, comprising:
 positioning an end effector coupled to a distal end of an elongate shaft at a surgical site in a first configuration such that a longitudinal axis of the elongate shaft lies in a first plane, the end effector having a first jaw that pivots relative to a second jaw about an axis that extends through a proximal end of the first jaw and a portion of the second jaw; 
 articulating the end effector relative to the elongate shaft in a direction transverse to the first plane such that the end effector moves to a second configuration in which the first plane is transverse to the longitudinal axis of the elongate shaft; and 
 drawing tissue through the first and second jaws in a direction transverse to the first plane; 
 wherein the first plane is defined by lengths of the first and second jaws in both the first configuration and the second configuration. 
 
     
     
       8. The method of  claim 7 , wherein drawing the tissue through the first and second jaws includes engaging the tissue with a tissue grasper capable of moving independently from the end effector. 
     
     
       9. The method of  claim 7 , wherein the end effector is positioned such that the first plane is transverse to a tissue surface prior to articulation of the end effector and is parallel to the tissue surface after articulation of the end effector. 
     
     
       10. The method of  claim 7 , further comprising delivering a fastener through the tissue disposed between the first and second jaws. 
     
     
       11. The method of  claim 10 , wherein the fastener is delivered through a flexible fastener delivery member that extends from the elongate shaft and is coupled to the second jaw. 
     
     
       12. The method of  claim 11 , wherein delivering the fastener includes extending a needle from the flexible fastener delivery member such that the needle passes through openings formed in the first and second jaws, as well as through the tissue disposed therebetween. 
     
     
       13. A method for acquiring and fixating tissue, comprising:
 inserting into a body lumen an end effector having first and second jaws that are pivotally coupled to one another, the end effector being coupled to an elongate shaft and arranged in a first configuration such that a longitudinal axis of the elongate shaft lies in a first plane; 
 approaching a tissue surface such that the first plane and the longitudinal axis of the elongate shaft are transverse to the tissue surface; 
 articulating the end effector relative to the elongate shaft about a pivot point located proximal to a location of pivotal coupling between the first and second jaws in a direction transverse to the first plane such that the end effector moves to a second configuration in which the first plane is substantially parallel to the tissue surface and transverse to the longitudinal axis of the elongate shaft; 
 drawing tissue through the first and second jaws using a tissue grasper that can move independently from the end effector; and 
 delivering a fastener through the tissue disposed between the first and second jaws; 
 wherein the first plane is defined by relative movement of the first and second jaws in both the first configuration and the second configuration. 
 
     
     
       14. The method of  claim 13 , wherein delivering the fastener includes moving a fastener delivery member from a low-profile delivery configuration in which the fastener delivery member is positioned substantially within a channel formed in the second jaw to an open configuration in which a distal portion of the fastener delivery member is positioned substantially outside of the channel. 
     
     
       15. The method of  claim 14 , wherein delivering the fastener further includes extending a needle from the fastener delivery member such that the needle passes through openings formed in the first and second jaws, as well as through the tissue disposed therebetween.